Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital of Sichuan University, Chengdu, Sichuan.
Department of Endocrinology and Metabolism, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou.
J Hypertens. 2020 Feb;38(2):347-353. doi: 10.1097/HJH.0000000000002271.
The current study aimed to investigate the value of the computed tomography-based left-versus-right adrenal gland volume ratio (L/Rv) in screening patients with unilateral primary aldosteronism.
The current study recruited 114 patients who underwent successful adrenal venous sampling (AVS) and adrenal computed tomography at West China Hospital of Sichuan University. The patients were divided into three groups according to the AVS results: AVS-left, AVS-bilateral, and AVS-right primary aldosteronism. The volumes of the left and right adrenal glands were semiautomatically calculated. The L/Rv of each patient was computed, and its value in identifying unilateral primary aldosteronism was analyzed.
The mean value of the L/Rv was larger in AVS-left patients and smaller in AVS-right patients than that in AVS-bilateral patients. In AVS-left primary aldosteronism patients, the cutoff value of the L/Rv with the highest Youden index was 1.344 [area under the curve (AUC) 0.851, sensitivity 80.0%, specificity 78.1%]. The optimal cutoff value was 1.908, of which 46.0% (23/50) of AVS-left primary aldosteronism patients could be identified (specificity 100.0%). In AVS-right primary aldosteronism patients, the cutoff value of the L/Rv with the highest Youden index was 1.267 (AUC 0.868, specificity 72.8%, sensitivity 87.9%). The optimal cutoff value was 0.765, of which 27.3% (9/33) of AVS-right primary aldosteronism patients could be identified (specificity 100.0%). Patients with L/Rv more than 1.908 or less than 0.765 had higher complete success rate postsurgery.
Although not perfect, the L/Rv is an applicable index to screen unilateral primary aldosteronism patients for surgery. Primary aldosteronism patients, even those aged more than 35 years, with an L/Rv more than 1.908 or less than 0.765 can be spared AVS before surgery.
本研究旨在探讨基于 CT 的左-右侧肾上腺体积比（L/Rv）在单侧原发性醛固酮增多症患者筛查中的价值。
本研究纳入了在四川大学华西医院成功接受肾上腺静脉采样（AVS）和肾上腺 CT 检查的 114 例患者。根据 AVS 结果，患者被分为 AVS-左侧、AVS-双侧和 AVS-右侧原发性醛固酮增多症 3 组。半自动计算左、右侧肾上腺的体积，计算每位患者的 L/Rv，并分析其对单侧原发性醛固酮增多症的诊断价值。
AVS-左侧患者的 L/Rv 平均值大于 AVS-双侧患者，而 AVS-右侧患者的 L/Rv 平均值小于 AVS-双侧患者。在 AVS-左侧原发性醛固酮增多症患者中，L/Rv 的最佳截断值为 1.344（曲线下面积 [AUC] 0.851，灵敏度 80.0%，特异性 78.1%）。最佳截断值为 1.908，其中 46.0%（23/50）的 AVS-左侧原发性醛固酮增多症患者可被识别（特异性 100.0%）。在 AVS-右侧原发性醛固酮增多症患者中，L/Rv 的最佳截断值为 1.267（AUC 0.868，特异性 72.8%，敏感性 87.9%）。最佳截断值为 0.765，其中 27.3%（9/33）的 AVS-右侧原发性醛固酮增多症患者可被识别（特异性 100.0%）。L/Rv 值大于 1.908 或小于 0.765 的患者术后完全缓解率更高。
虽然不够完美，但 L/Rv 是一种可用于筛选单侧原发性醛固酮增多症患者进行手术的指标。对于手术患者，即使年龄大于 35 岁，L/Rv 值大于 1.908 或小于 0.765 的患者可以避免术前 AVS。
